The invention relates to a seal for closing-off a proximal-side access port of an access instrument.
Widely available, minimally invasive surgery has introduced obtaining access to an inner cavity of a body by means of an access instrument. Trocars are such access instruments, the trocar sleeve of which pierces the abdominal wall in e.g. laparoscopy. So that this is brought about as atraumatically as possible, a small incision, usually with a length of 1-1.5 cm, is firstly introduced into the skin, the trocar with a pointed trocar pin is placed onto said incision and then pushed through the abdominal wall. The trocar sleeve is removed again after the intervention and the incision is closed. After a certain amount of time, nothing relating to the surgery can be seen on the outside, bar a small scar in the skin. There are certain limits to the diameter of the trocar sleeve, which are in the region of approximately 15 mm.
However, since minimally invasive surgery in e.g. the internal abdominal cavity requires that a number of instruments are guided through, it has become conventional to place a plurality of trocars on e.g. the abdominal wall in such an intervention, with 3 to 4 trocars by all means being common.
In a development of this access technology, the applicant has developed an access instrument into a body, which instrument allows the creation of a significantly larger access port, particularly when the access instrument is inserted through the navel, and therefore a plurality of instruments can be guided through this access instrument at the same time. That is to say, only a single access instrument is necessary, with the single, relatively large access port thereof allowing simultaneous guiding-through of a plurality of instruments (Single Port Access).
The body of such an access instrument is made up of, for example, two parts, with each part having a distal body section, which merges into a proximal body section protruding outwardly from the central longitudinal axis. The distal body sections can be assembled in a first position to form a distal body with laterally protruding proximal body sections. The two assembled distal body sections together virtually form a trocar sleeve and can be pushed through the abdominal wall in laparoscopy, as described above. Here, the diameter can be of the order of conventional trocar sleeves. Subsequently, the two subsidiary body sections protruding laterally from the body are assembled by swivelling or mutual approaching to form a proximal hollow body, the outer proximal edge of which constituting the access port of the access instrument.
During this swivelling, the two distal body sections sticking in the body and originally folded together are moved apart and swivelled. As a result of an appropriate embodiment of the transition region between the distal and proximal body sections, this swivelling can widen the port in the abdominal wall a little further. The two proximal body sections can delimit a port on their proximal edge, which port has a diameter of a plurality of centimeters.
This affords the possibility of simultaneously inserting a plurality of instruments into the body through such a single access instrument.
More detailed refinements of such an access instrument are described in more detail and explained in the German patent application by the applicant with the official reference number 10 2009 014 525.7, dated 13 Mar. 2009, and so, the content of this application is inserted into the present application by reference.
If there is a desire to seal such an access instrument in the proximal direction, a seal has to be placed thereon. In laparoscopic surgery an insufflation gas is supplied through the access instrument in order to inflate the abdominal wall and enlarge the internal cavity. Such a seal is provided to prevent the gas from escaping.
Thus, the subject matter of the present invention relates to such a seal for closing-off a proximal access port of an access instrument into a body.
EP 1 314 392 B1 discloses a seal for an endoscope, in which different seals are inserted into ports, a plurality of said ports being provided in the wall of a rigid cap that can be screwed onto the end of an endoscope. All of these ports are circular and the ports serve to seal, in a gas-tight fashion with respect to the outside, a shaft of an instrument pushed through this seal. In some seals, the proximal-side port, through which the shaft of an instrument should be pushed through in a sealing fashion, is smaller than the port in the cap into which the seal has been inserted. In order to allow a certain amount of lateral or tilting movement of the instrument inserted through the seal, the body of said instrument is designed as bellows.
It is therefore an object of the present invention to create a seal for closing-off a proximal-side access port of an access instrument into a body, which simultaneously allows the guiding of a plurality of instruments through the seal and simultaneously allows moveable handling, i.e. to-and-fro movement and tilting, of the guided-through instruments in a region which is as large as possible.